The Clock Is Ticking – Brain Atrophy in Case of Acute Trauma? / 대한신경손상학회지

OBJECTIVE: Brain atrophy and brain herniation are gaining a lot of attention separately, but a limited amount of studies connected them together, and because of this, we are going to review and examine the subject in the current meta-analysis. METHODS: The authors collected data reporting brain atrophy of alcoholic and schizophrenic cause, as well as data on control patients, all of which was published on MEDLINE between 1996 and 2018. The included 11 articles were processed with a statistical program. RESULTS: We found that the pericerebral space is unequal among the groups, while the intracranial volume is strongly correlated to the biggest foramen of the body. The effect of this inequality, however, is expressed in emergency cases, where the patients with brain atrophy will have more time before the final stage of brain herniation CONCLUSION: The current study raises a controversial issue that requires careful investigation and high attention from the health care personnel.

Monitoring of cerebrospinal fluid dynamics in a model of brain herniation induced by acute intracranial hypertension by PC cine MRI / 中华急诊医学杂志

Objective To explore the monitoring of cerebrospinal fluid (CSF) dynamics in a model of brain herniation induced by acute intracranial hypertension in Guangxi Bama-Mini pigs by phasecontrast cine magnetic resonance imaging (PC cine MRI).Methods Femoral artery blood were extracted from 10 pigs,and injected into the frontal and temporal parietal lobe to make a model of brain herniation induced by acute intracranial hypertension.The mean arterial blood pressure (MAP),intracranial pressure (ICP),and cerebral perfusion pressure (CPP) were monitored.Routine T1WI,T2WI,coronal,sagittal and cerebrospinal fluid flow sequence (fast PC cine slice) which positioned on the cervical 3 (C3) vertebral body as the center and perpendicular to the spinal scans were performed on all experimental animals before and after blood injection with 3.0T Magnetic Resonance Imaging.The ICP,MAP,CPP,the absolute values of CSF peak flow velocity and the absolute value of carotid peak flow velocity before and after blood injection were compared.Results The ICP,MAP,CPP,and the absolute value of CSF peak flow velocity before injection of autologous arterial blood were statistically significant as compared with those after blood injection [(6.80±2.044) mmHg vs (52.20±1.619) mmHg,(76.80±7.068) mmHg vs (142.80±12.399) mmHg,(70.00±6.074) mmHg vs (90.50±12.250) mmHg,and the absolute value of CSF peak flow velocity was (243.20±77.671) mm/s vs (201.40±55.482) mm/s,respectively,P＜0.01].The absolute value of the peak velocity of the carotid artery before blood injection was not statistically significant compared with that after blood injection [(876.80±239.908) mm/s vs (799.40±241.829) mm/s,P＞0.05].Conclusion After the formation of brain herniation induced by acute intracranial hypertension,the CSF flow in the C3 level spinal canal showed a low dynamic change,and the CSF flow velocity waveform was disordered and malformed.The non-invasive measurement of CSF dynamics by PC cine MRI can provide an important basis for the change of CSF dynamics in the model of brain herniation induced by acute intracranial hypertension,and provide a theoretical basis for further research on damage control neurosurgery in the future.

Encephalocele presenting as lower lid swelling: A rare case report

Encephalocele is a rare congenital abnormality characterized by abnormal protrusion of brain and meninges through an opening in the skull. We report an 8-year-old girl who presented with a swelling in the right lower lid for the last 6 years. In her infancy, she had undergone surgery for a very small swelling located in the right nasolacrimal area. On further clinicoradiological evaluation, anterior encephalocele was diagnosed. This case highlights the uncommon site of anterior encephalocele; misdiagnosis and mismanagement of which could result in dreaded complications such as meningitis and cerebrospinal fluid leaking fistula formation.

Intractable intraoperative brain herniation secondary to tension pneumocephalus: a rare life-threatening complication during drainage of subdural empyema / Herniação cerebral intratável secundária a pneumoencéfalo hipertensivo no intraoperatório: uma complicação rara com risco para a vida durante a drenagem de empiema subdural

Abstract Tension pneumocephalus is rare but has been well documented following trauma and neurosurgical procedures. It is a surgical emergency as it can lead to neurological deterioration, brainstem herniation and death. Unlike previous cases where tension pneumocephalus developed postoperatively, we describe a case of intraoperative tension pneumocephalus leading to sudden, massive open brain herniation out of the craniotomy site. The possible causative factors are outlined. It is imperative to rapidly identify possible causes of acute intraoperative brain herniation, including tension pneumocephalus, and institute appropriate measures to minimize neurological damage.

Resumo O pneumoencéfalo hipertensivo é raro, mas foi bem documentado após trauma e procedimentos neurocirúrgicos. Trata-se de uma emergência cirúrgica porque pode levar à deterioração neurológica, herniação do tronco cerebral e morte. Ao contrário de casos anteriores, nos quais o pneumoencéfalo hipertensivo se desenvolveu no pós-operatório, descrevemos um caso de pneumoencéfalo hipertensivo desenvolvido no período intraoperatório que levou a uma herniação cerebral súbita, maciça e aberta para fora do local da craniotomia. Os possíveis fatores causais são destacados. É imperativo identificar rapidamente as possíveis causas da herniação cerebral aguda no intraoperatório, incluindo o pneumoencéfalo hipertensivo, e instituir medidas apropriadas para minimizar os danos neurológicos.

Magnetic Resonance Imaging of Idiopathic Herniation of the Lingual Gyrus: a Case Report

Idiopathic brain herniation is a rare condition. We believe that this is the first reported case of idiopathic herniation of the lingual gyrus. The case involves a 57-year-old woman presenting with frontal headache without overt visual symptoms. Magnetic resonance imaging (MRI) revealed an idiopathic herniation of the lingual gyrus of the occipital lobe extending into the quadrigeminal cistern. No other adjacent intracranial abnormalities were observed. Although some conditions may be considered in the differential diagnosis, accurate diagnosis of idiopathic brain herniation in medical practice can prevent unnecessary additional imaging procedures and invasive open biopsy in patients with typical imaging findings.

Spontaneous Spinal Subdural Hematoma Concurrent with Cranial Subdural Hematoma

A 39-year old female presented with chronic spinal subdural hematoma manifesting as low back pain and radiating pain from both legs. Magnetic resonance imaging (MRI) showed spinal subdural hematoma (SDH) extending from L4 to S2 leading to severe central spinal canal stenosis. One day after admission, she complained of nausea and severe headache. Computed tomography of the brain revealed chronic SDH associated with midline shift. Intracranial chronic SDH was evacuated through two burr holes. Back pain and radiating leg pain derived from the spinal SDH diminished about 2 weeks after admission and spinal SDH was completely resolved on MRI obtained 3 months after onset. Physicians should be aware of such a condition and check the possibility of concurrent cranial SDH in patients with spinal SDH, especially with non-traumatic origin.

To analysis the treatment effection of 53 cases of cranial decompression under temporal muscle in very-low position with large bone flap for severs cranial trauma / 中国基层医药

Objective To investigate the treatment effection of cranial decompression under temporal muscle in very-low position with large bone flap for severe cranial trauma.Methods 53 cases of severs cranial traumatic brain herniation were derided into two groups.22 cases with unilateral dilated pupil,and 31 cases of bilateral dilated pupil,all the patients were treated with cranial decompression under temporal muscle in very low position with large bone-flap.The ICP,appearance rate of cisternal,pupil contraction rate and GCS evaluation were observed,recorded and statistiely analysised.Results According to the intraeranial pressure monitoring,the rate of 24h ICP＜20mmHg was increased significantly,and the rate of 72h ICP＞40mmHg was decreased in both groups.The occurance rate of cisternal:81.82% in unilateral dilated pupil group,and 51.61% in bilateral dilated pupil group.The recoverance rate of pupil in 24h:77.2% in unilateral dilated pupil group,and 32.26% in bilateral dilated pupil group.GCS evaluation:All of the patient's average mark of GCS after operation wag(8.02±3.03)which increased(3.92±2.21)compared with the mark of GCS before operation,which was(4.10±0.82),with a significant difference(P＜0.01).Treat outcome:well/moderate disability:64.15%,severe/long-term coma:7.55%,and death:28.30%.Conclusion Cranial decompression under temporal muscle in very-low position with large bone-flap for severe cranial trauma can enlarge the cranial capacity effectively,increase the decompression space in dorsolateral cranium,which can alleviate the intracranial pressure in axial centre of brain truak,promote the effeetion of the brain herniation restore and the recover of the brain trauma.

A Case Report of Brain Herniation into the Middle Ear Mimicking as Secondary Cholesteatoma Following Temporal Bone Fracture / 대한이비인후과학회지

Brain herniation into the middle ear cavity is a rare entity that occurs mostly as a complication of otologic surgery. Other causes include a congenital skull base defect, infection, trauma, neoplasm and irradiation. It gives rise to cerebrospinal fluid otorrhea, progressive hearing loss, tinnitus, meningitis and other neurologic symptoms. Such patients tend to be misdiagnosed as having chronic otitis media and are often treated for long periods with inadequate conservative therapy. We report a case of brain herniation into the middle ear following traumatic temporal bone fracture, which was treated surgically via a transmastoid approach.

Bilateral Cortical Blindness Caused by Tentorial Herniation due to Brain Tumor

Two patients, one with glioblastoma multiforme (GM) in the right thalamus and the other with meningioma at the right frontal convexity, had suffered bilateral cortical blindness after transtentorial herniation. On one of those patients, bilateral cortical blindness had occurred due to acute obstructive hydrocephalus caused by GM and on the other patient, cortical blindness had developed after acute hemorrhage from meningioma. Bilateral occipital lobes of those patients showed signal change on the brain magnetic resonance image (MRI). There were no ophthalmologic abnormalities on fundoscopy and ophthalmologic examination. After recovery of consciousness, cortical blindness was detected in both patients, and during gradual recovery period, visual function was slowly recovered. The pattern of visual evoked potential (VEP) at 7 weeks and 12 weeks after herniation was normalized gradually. Cortical blindness due to herniation was reversible, even though the high signals of bilateral visual cortex still existed on MRI 16 months later in case 2.

Surgical Management of Massive Cerebral Infarction

OBJECTIVE: The aim of this study was to analyze the treatment results and prognostic factors in patients with massive cerebral infarction who underwent decompressive craniectomy. METHODS: From January 2000 to December 2005, we performed decompressive craniectomy in 24 patients with massive cerebral infarction. We retrospectively reviewed the medical records, radiological findings, initial clinical assessment using the Glasgow Coma Scale, serial computerized tomography (CT) with measurement of midline and septum pellucidum shift, and cerebral infarction territories. Patients were evaluated based on the following factors : the pre- and post-operative midline shifting on CT scan, infarction area or its dominancy, consciousness level, pupillary light reflex and Glasgow Outcome Scale. RESULTS: All 24 patients (11 men, 13 women; mean age, 63 years; right middle cerebral artery (MCA) territory, 17 patients; left MCA territory, 7 patients) were treated with large decompressive craniectomy and duroplasty. The average time interval between the onset of symptoms and surgical decompression was 2.5 days. The mean Glasgow Coma Scale was 12.4 on admission and 8.3 preoperatively. Of the 24 surgically treated patients, the good outcome group (Group 2 : GOS 4-5) comprised 9 cases and the poor outcome group (Group1 : GOS 1-3) comprised 15 cases. CONCLUSION: We consider decompressive craniectomy for large hemispheric infarction as a life-saving procedure. Good preoperative GCS, late clinical deterioration, small size of the infarction area, absence of anisocoria, and preoperative midline shift less than 11mm were considered to be positive predictors of good outcome. Careful patient selection based on the above-mentioned factors and early operation may improve the functional outcome of surgical management for large hemispheric infarction.

Systematic therapy on severe head injury with brain herniation / 中国康复理论与实践

@#Objective To explore the treat methods in severe head injury (SHI) with brain herniation.Methods 73 patients suffered from SHI with brain herniation, who were undertaken system therapy in every different phase of post-trauma, were analyzed retrospectively.Results There were 17 patients died and 14 patients was GOS Ⅴ grade.Conclusion The systematic therapy in every different phase can enhance the synthetic therapeutic level of SHI and reduce the mortality and elevate the quality of life.

A clinical study on brain herniation in patients with moderate craniocerebral injury during subacute phase after truma / 重庆医科大学学报

Objective:To summrize the clinical features of brain herniation in patients with moderate craniocerebral injury during subacute phase after truma and to study the etiology.Methods:The data of 33 cases of brain herniation in patients with moderate craniocerebral injury during subacute phase after truma in the department where the authers worked from 1997 to 2005 were studied retrospectively.Results:Hematoma formation after cerebral contusion,cerebral edema after cerebral contusion,delayed intracerebral hematomas formation were main causes of brain herniation in patients with moderate craniocerebral injury during subacute phase after truma.There were 28 patients had been treated surgically after exacerbation.22 cases had a good prognosis and 5 cases died of cerebellar tonsillar herniation.Conclusion:The conditon of most patients with moderate craniocerebral injury during subacute phase after truma is stable,while some cases worsen and even develop into brain herniation,and the incidence of disablity and mortality rise significantly.

The characteristics of CT images of encephalocele

30 eyes of 28 patients (18 female, 10 male, aged 45-75) of primary glaucoma (25 eyes with closed angle glaucoma and 5 eyes with opened angle glaucoma) at the National Institute of Ophtalmology were operated. No complications occurred. In postoperative period, there were 4 eyes with low interocular pressure and very shallow vestibule. In discharge, 46.6% eyes got a visual acuity of 4/10 to >6/10, and 13.3% <1/10, interocular pressure was regulated with X=18.20.8 mmHg. All operated eyes had scars. After 1 year, acuity visual had been re-examined on 28 eyes, no change of visual acuity, vision field and scars. Interoculary pressure was normal level of X=19.61.2 mmHg

A Case of Brain Hernia in Mastoid Cavity / 대한이비인후과학회지

Brain tissue herniation into the mastoid cavity is an uncommon phenomenon: nevertheless, it has been described since the earliest years of this century. Serious sequelae and central nervous system infection may result from inadequate management, but it has become relatively rare with improved antibiotic treatment and surgical technique. It might be caused by chronic otitis media, previous ear surgery, trauma and neoplasm, or spontaneously. Spontaneous brain herniation is extremely rare. It gives rise to cerebrospinal fluid otorrhea, progressive hearing loss, meningitis and other neurologic symptoms. Treatment depends on site and size of dura defect. We experienced one case of spontaneous brain herniation into the mastoid cavity, which we treated with surgery.

A Case of Exophthalmos due to Traumatic Orbital Encephalocele

Exophthalmos after trauma may develop because of retrobulbar hemorrhage, carotid cavernous fistula and orbital roof fracture. The orbital roof is composed of two layers of strong bone that makes it the strongest among the orbital walls and reports of its case are hardly found. However, rarely strong impact such as in automobile accidents causes these fractures and exophthalmos may develop due to herniation of brain tissue through a traumatic defect in the roof of the orbit. The authors experienced gradually increasing exophthalmos in a 33-year old man who had developed a subdural hematoma, orbital roof fracture and anterior temporal skull fracture due to an automobile accident. We report a case of orbital roof fracture in which herniation of brain was shown in orbital computed tomography and exophthalmos disappeared after dural suture.